Monday, April 19, 2010

Interesting article about HRT in yesterday's New York Times Magazine

You can read it online here, and I highly recommend you do so if you're a woman of a certain age or anticipate becoming one at some point:

The gist of the article essentially is that there are some flaws in the Women's Health Initiative study from a while back that had to be stopped after three years because the study subjects seemed to be dropping like flies from stroke, breast cancer, and so forth, apparently due to the hormone replacement therapy they were receiving. Scary stuff, and as a result of that study most doctors no longer recommend hormone replacement therapy as a matter of course to their midlife female patients. In fact many don't recommend it at all for fear of malpractice suits.

And that may not be such a good thing for women, because if you take a closer look at the WHI study you'll see that all it really proves for sure is that estrogen-only HRT is an unacceptably risky proposition for post-menopausal women. None of the study subjects were still menstruating, and none were receiving progesterone in addition to estrogen.

The scary thing is that there've been no large-scale studies involving pre-menopausal women who're receiving a cocktail of estrogen and progesterone, so no one knows for sure whether this type of therapy is safe for this age group. Which might cause you to wonder: why on earth would any sensible woman be willing to risk it?

I can answer that one. Hot flashes suck, as do night sweats and disrupted sleep. But they're manageable. More problematic are the moments of homicidal rage alternating with suicidal despair. I'm trying to be funny here, but honestly there's nothing amusing about it. I suffered from clinical depression for years, and I know a thing or two about suicidal ideation. Once I started on SSRIs it went away ... until I turned 47. Paint it black, people. Paint it black.

Bear in mind, not every woman is going to have this issue. It may be limited to those fortunate few who are genetically predisposed to depression. But for us, some sort of combination HRT might conceivably make sense, at least for those of us who are not also at an unsually high risk of developing breast cancer.

I frankly don't know what makes the most sense for me. Nor do I know whether my doctor will even be willing to have a dialogue with me about it. But I've got a few more menstruating years in which to decide, and hopefully there will be more research that may help me with my risk-benefit analysis.

I'll keep you posted.